BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BREEZY WHEELCHAIR

    MDR report key: 61118 · Received January 8, 1997

    Report

    Report Number
    2082643-1997-00049
    Event Type
    Malfunction
    Date Received
    January 8, 1997
    Date of Event
    January 7, 1997
    Report Date
    January 8, 1997
    Manufacturer
    QUICKIE DESIGNS, INC.
    Product Code
    IOR
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    BZ-X-TUBE ASSEMBLY 18" X 16" PNTD. BROKEN AT CTR BOLT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BREEZY WHEELCHAIR WHEELCHAIR-MECHANICAL IOR QUICKIE DESIGNS, INC. NA P/N-673080

    Patients

    Seq Age Sex Outcome Treatment
    1 30 YR Other